q Growing Seat Sling N/C q Growing Solid Seat Pan E2231 $245 q Omit Seat N/C q 1 N/C

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1 This form must be opened in Adobe Acrobat. The Submit Form button will not work from most browser windows. Company: Account Number: Date: q Quote q PO Number: RTS: Marked For: Little Wave - Clik XPe K0005, E1235 $2315 Width Growable Frame. Price does not include one time free growth kit. 165 lb weight capacity. Maximum Seat Width of 18. End User Weight: lbs (Required with Frog Legs Forks) Patent Pending Ship To: Address: City: State: Zip: Phone: /Fax: Effective 02/22/2019 Frame Seat Width / Seat Depth Select box corresponding to desired Seat Width and Depth. See references A and B on page 7. Seat Depth Seat Width q q q q q q 9 q q q q q q q 10 q q q q q q q q 11 q q q q q q q q q 12 q q q q q q q q q 13 q q q q q q q q q 14 q q q q q q q q 15 q q q q q q q 16 q q q q q q Adjustable Depth Adds the capability to grow seat in depth. For restrictions see Chart 2 on page 7. q No Rear Adjustment N/C q 1 N/C q 2 N/C q 3 N/C Transit Option q Transit System K0108 $220 Offset Option See Chart 1 on page 7 q Offset Frame N/C Not available with 0 and -1 Sling Positions Seat Option q Growing Seat Sling N/C q Growing Solid Seat Pan E2231 $245 q Omit Seat N/C Sling Position With 0 Sling Position, sling is approximately 4 from front down tube. The 1 and 2 Sling Positions extend the frame in front of the sling by that amount. -1 pushes the seat 1 farther forward. See reference D on page 7 for further detail and restrictions. q 2 N/C q 1 N/C q 0 N/C Not available with Offset Frame q -1 N/C Not available with Offset Frame Front Caster Wing Certain combinations of Seat Depth, Center of Gravity Position and Wheel Size may require a forward facing caster wing q Forward Facing Wing N/C Front Frame Bend Angle between front seat tube and ground. See reference C on page 7. q 90º N/C q 85º N/C q 80º N/C HCPCS codes provided are based on code verification by the PDAC or our interpretation of the code definitions. Proper use of HCPCS codes does not ensure coverage or payment. For coverage information, verify the appropriate payer s coverage policy. DCN Pricing and specifications subject to change without notice Page 1 of 14

2 Backrest Back Post / Height Range / Back Height Select Back Height in row corresponding to desired Back Post and Height Range Back Post Height Adjustable (Standard or 1 Inward Offset) Fixed Height (Straight or 1 Inward Offset) Fixed Height 2 Offset Height Range Back Height Ex. Short 1 q 9 q 10 q 11 q 12 Short q 11 1 q 12 q 13 q 14 Medium q 13 q 14 q 15 q 16 Tall q 15 q 16 q 17 q 18 q 9 1 q 10 1 q 11 1 q 12 q 13 q 14 q 15 q 16 q 17 q 18 q 11 1 q 12 1 q 13 1 q 14 1 q 15 q 16 q 17 1 Not available with Fold Down Push Handle Height Adjustable Back Post Option Selection required with Height Adjustable Back Post. Each Offset Back Post is offset 1/2 creating 1 overall offset. q Standard N/C q 1 Inward Offset N/C Not available with 8 Seat Width Fixed Height Back Post Option Selection required with Fixed Height Back Post. Uses 1 tubes compatible with after-market backs. Not available with back upholstery. 2 Inward or Outward Offset Back Posts are offset 1 creating 2 overall offset. 1 Offset Back Post is offset 1/2 creating 1 overall offset. q Straight N/C q 1 Inward Offset N/C Not available with 8 Seat Widths q 2 Inward Offset $95 Not available with 8 or 9 Seat Widths q 2 Outward Offset $95 Not available with Swing Away Armrests or 8 and 9 Seat Widths Push Handle q Omit Push Handle N/C q Standard Push Handle N/C q Fold Down Push Handle $100 Not available on Height Adjustable Back Posts with 9-11 Back Heights or Offset Back Posts with Back Heights q Bolt-On Push Handle $175 Handles will be 1-2 above back height Stroller Handle Stroller Handles are removable and height adjustable q Ergo Stroller Handle $185 q Single Straight Stroller Handle $165 q Double Straight Stroller Handle $330 Not available with Push Handles or 8-10 Seat Widths Back Upholstery Available only with Height Adjustable Back Posts q Padded Velcro Adjustable Std Not available with 17 or 18 Back Heights in combination with 8 or 9 Seat Widths q Tension Adjustable E2611 $295 Not available with 8 and 9 Seat Widths or 10 Seat Width and 1 Inward Offset q Omit Back Upholstery N/C Seat Back Angle Standard is 90º (perpendicular to floor). Minus (-º) closes back angle. Plus (+º) opens back angle. q Std q +2º q +4º q +6º q +8º q +10º q -2º q -4º q -6º q -8º q -10º Spinergy Backrest Release Cable Color Select desired color. If no selection is made, black will be used. q Black q Red q White q Blue q Yellow q Orange q Green q Pink DCN Pricing and specifications subject to change without notice Page 2 of 14

3 Front Seat Height and Casters Caster Size / Front Seat Height Select Front Seat Height in row corresponding to desired Caster Size. Front Seat Height is measured from floor to top of seat tube at front of seat sling. Adjustable up or down by 1/2. See reference E on page 7. Caster Size Front Seat Height 3 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 q 20.5 Caster Type q.75 Rollerblade N/C Available only with 3 and 4 Caster Sizes q.75 Lighted Rollerblade $70 Not available with 6 Caster Size q 1 Poly Std Not available with 3 Caster Size q 1 Poly Aluminum $100 Available only with 4 and 5 Caster Sizes q 1 Pneumatic $85 Available only with 6 Caster Size q 1.5 Poly $50 Not available with 3 Caster Size q 1.5 Soft Roll Aluminum $175 Footrest Footplate q Aluminum Angle Adjustable K0040 $95 Not available with Front Seat Heights less than 14.5 q Aluminum Angle Adjustable with Riser K0040, K0037 $185 Not available with Front Seat Heights less than 14.5 q High Mount Aluminum Angle Adjustable K0040, K0037 $160 q Angle Adjustable Flip Under K0040, K0037 $185 Not available with footrest widths less than 9 or with Front Seat Heights less than 15. See reference F on page 7. q High Mount Angle Adjustable Flip Under K0040, K0037 $270 Fork Options q Standard Fork Std q Single Sided Fork $125 q Frog Legs Ultra-Sport Fork - Black E1015 $425 Not included in Colored Anodizing Package q Frog Legs PHASE 2 Carbon Fork $425 Lightweight shock absorbing fork. Not included in Colored Anodizing Package. Seat to Footrest Length Measured from front edge of seat sling to top, rear of footrest. Footrest length at least 2.5 shorter than Front Seat Height recommended. See reference G on page 7. q 5.5 q 6 q 6.5 q 7 q 7.5 q 8 q 8.5 q 9 q 9.5 q 10 q 10.5 q 11 q 11.5 q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 DCN Pricing and specifications subject to change without notice Page 3 of 14

4 Rear Seat Height and Wheels Wheel Size / Rear Seat Height Select Rear Seat Height in row corresponding to desired Wheel Size. For proper setup, selection is required when omitting rear wheels. Measured from floor to top of seat tube at front of back post. Rear Seat Height is custom to needs. See reference H on page 7. Wheel Rear Seat Height Size 18 q q 12 q 12.5 q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q q q 13 q 13.5 q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q q q 14 q 14.5 q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q q q 15 q 15.5 q 16 q 16.5 q 17 q 17.5 q 18 q 18.5 q 19 q 19.5 q 20 1 Available only with Low Profile tires One Arm Drive One Arm Drive E0958 $1495 Available only with 20, 22 and 24 Mag wheels. Not available with Seat Widths less than 10. Axle not quick release. Standard Handrim will be Aluminum Anodized. Drive Handrim Side: q Left q Right Drive Handrim Type: q Aluminum N/C q Poly Coated $200 Rear Wheel Type q Spoke Std q MAXX Performance Spoke New! $99 Available only in 22 and 24 wheel sizes q Mag (Black) $50 Not available in 18 wheel size Colored Mag $100 Available only in 20 and 22 wheel sizes Color: q Florescent Red q White q Blue q Pink Spinergy Spox $820 Not available in 18 wheel size Color: q Black q Red q White q Blue q Yellow Handrim: q Short Tab q Long Tab Available only with Aluminum Anodized and Plastic Coated Handrims Spinergy LX $1025 Not available in 18 or 20 wheel sizes Color: q Black q Red q White q Blue q Yellow q Pink q Green q Orange q Purple New! Handrim: q Short Tab q Long Tab Available only with Aluminum Anodized and Plastic Coated Handrims q Omit Rear Wheels N/C Wheelchair Drive Ready Chair will ship from Ki Mobility with adaption kit installed for selected Alber system. Order system separately from Alber USA. Select Rear Seat Height (full profile selections only) in drive wheel size on Rear Seat Height chart above. Requires Rear Anti-Tips. Not available with 5th Wheel or Spinergy wheels. q e-motion Ready N/C q twion Ready N/C Camber Selection: q 0º q 3º Rear Tire Type Full Profile q Street Pneumatic 1 3/8 E2211, E2212 Std q Full Poly 1 3/8 E2218 $75 q Pneumatic with Airless Insert 1 3/8 E2211, E2213 $95 Low Profile q Low Poly 1 E2218 $75 q Sentinel Solid Tire 1 E2218 $95 Not available on 18 wheel size or 20 and 22 Mag wheels q High Pressure 1 E2211, E2212 $95 Not available on Mag wheel or 18 wheel size q Schwalbe Marathon Plus Evolution 1 E2211, E2212 $135 Available only on 24 Spoke or Spinergy wheels Handrim No selection needed with One Arm Drive Standard Handrims q Aluminum Anodized Std q Plastic Coated $95 q Projection (8 Vertical Projections) $315 Available only with full profile tires. Available only with Spoke wheel sizes or Mag wheel q Omit Handrim Natural Fit Handrims Not available on 18 or 20 wheel sizes or 22 Mag wheel. Not recommended with Mag wheel. q Natural Fit LT Regular Grip $445 q Natural Fit Standard Regular Grip $445 q Natural Fit LT Super Grip $495 q Natural Fit Standard Super Grip $495 q Natural Fit LT Omit Grip $345 q Natural Fit Standard Omit Grip $345 Handrim Option q 3M Micro Grip $65 Not available on Plastic Coated or Projection Handrims DCN Pricing and specifications subject to change without notice Page 4 of 14

5 Rear Seat Height and Wheels continued Axle q Quick Release Std q Quad Quick Release $185 Not available with Mag or Spinergy wheels Rear Wheel Spacing Adjustable up to.5 outward. Minimum spacing with offset frame is 1.25 with 0º camber, 1 with 2º or 4º camber and.75 with 6º or 8º camber..75 minimum with 0º camber on standard frame. No selection needed with One Arm Drive or Wheelchair Drive Ready option. See Reference J on page 7. q.5 q.75 q 1 q 1.25 q 1.5 q 1.75 Rear Wheel Camber No selection needed with One Arm Drive. 0º Camber and Mag wheel combination requires 1 minimum Rear Wheel Spacing. q 0º q 2º q 4º q 6º q 8º Wheel Locks Wheel Lock q Push to Lock Std q Push to Lock Flush Mount N/C Not available with Seat Depths less than 11 or Offset Frame q Pull to Lock N/C q Low Profile Scissor Lock $45 Not available with Low Poly, Full Poly, Sentinel tires or Offset Hanger q Short Thro Scissor Lock $125 q Omit Wheel Locks N/C Armrests Armrest Please select Arm Pad option q Height Adjustable T-Arm ( ) E0973 $265 Not available with Seat Depths less than minimum Seat Depth with Offset Frame minimum Rear Wheel Spacing. q Height Adjustable T-Arm Low ( ) E0973 $265 Not available with Seat Depths less than minimum Seat Depth with Offset Frame minimum Rear Wheel Spacing. q Height Adjustable Pediatric Desk ( ) E0973 $225 Seat Depth plus Sling Position must be at least 10. Seat Depth plus Sling Position must be at least 12 with Offset Frame 1.25 minimum Rear Wheel Spacing. q Angle Adjustable Locking Extendable Flip Up E0973 $265 Requires Fixed Height Backrest. Not available with backrest heights less than 12. Side Guards Center of Gravity Preset Measured from front of back post to center of rear axle. 0 indicates axle will be directly under back post. Center of Gravity setup may be limited with certain configurations. 2 minimum Center of Gravity with 5th Wheel and One Arm Drive and 0 minimum with Transit Option. See reference I on page 7. Amputee Positions q -1.5 q q -1 q -.75 q -.5 q -.25 q 0 q.25 Standard Positions q.5 q.75 q 1 q 1.25 q 1.5 q 1.75 q 2 q 2.25 q 2.5 q 2.75 q 3 q 3.25 q 3.5 q 3.75 q 4 q 4.25 Wheel Lock Options q Extension Handles E0961 $70 Available only with Push to Lock or Pull to Lock Wheel Locks q Grade Aids E0974 $150 Available only with Push to Lock Wheel Locks and Pneumatic or Pneumatic w/ Airless Insert tires Arm Pad Not available with Tubular Flip Up or Swing Away Armrests. Full Arm Pads not available with Height Adjustable Pediatric Desk Armrests. Standard Arm Pad N/C q Desk q Full Waterfall Arm Pad $25 q Desk q Full Not available with Angle Adjustable Locking Flip Up Extendable Armrests Foam Grip N/C q Desk q Full Available only with Angle Adjustable Locking Extendable Flip Up Armrest Armrest continued q Tubular Flip Up Std Requires Fixed Height Backrest. Not available with Arm Pads, Back Heights less than 13 or Back Heights less than 14 with Offset. q Short Swing Away (7-9 ) E0973 $195 Not available with Arm Pads or Outward Offset Back Posts. If selection is not available with rear wheel and rear seat height configuration, then Tall Swing Away armrest will be used. q Tall Swing Away ( ) E0973 $195 Not available with Arm Pads or Outward Offset Back Posts q Omit Armrests N/C Removable Side Guards Not available with Height Adjustable Armrests q Composite Side Guards - Adult (14-16 ) K0108 $140 Seat Depth plus Sling Position must be at least 12 q Composite Side Guards - Pediatric (10-14 ) K0108 $140 Seat Depth plus Sling Position must be at least 10 q Fender Side Guards K0108 $250 Not available with 18 wheel size or Seat Depths less than 10. Maximum Center of Gravity is 2. DCN Pricing and specifications subject to change without notice Page 5 of 14

6 Accessories 5th Wheel Rotating removable rear caster. Not available with Anti-Tips. q Standard 5th Wheel E0971 $210 Dynamic 5th Wheel K0108 $210 Elastomer: q Soft q Firm Both elastomers are included; the selected elastomer will be installed. Anti-Tip Not available with 5th wheel q Rear Anti-Tips E0971 $140 Calf Strap Not available with 8 or 9 wide chairs q Velcro Adjustable K0038 $35 q Padded Velcro Adjustable K0038 $68 q Bodypoint Padded AeroMesh K0038 $102 Positioning Belt q 1 Auto Buckle E0978 $70 q 1 Padded Auto Buckle E0978 $155 q 1 1/2 Auto Buckle E0978 $70 q 1 1/2 Padded Auto Buckle E0978 $155 q 2 Airline Buckle E0978 $110 Bodypoint Evoflex - Pelvic Stabilizer E0978 $183 Size: q Small (16-24 ) q Medium (19-29 ) q Large (25-37 ) Color Belt Mounting Kit q Ki Mobility Belt Mounting Clamp $50 Spoke Guards q Clear Spoke Guards K0065 $115 Not available with Mag wheel q Black Spoke Guards K0065 $115 Not available with 18 or 20 wheel sizes or Mag wheel Designer Spoke Guards K0065 $200 Available only with 20 and 22 wheel sizes. Not available with Mag wheel. Design: q Blue Monster q Fairy Garden q Havin a Hoot q Robo Fun q Rockin Reptiles q Super Puppies q Tutu Cute q Tuxedo Time Other Accessories q Tool Kit $45 q Removable Underseat Pouch $50 q Pediatric Ki Mobility Backpack $65 Best fit on chairs more than 8 wide q Ki Mobility Backpack $65 Best fit on chairs more than 10 wide q Luggage Carrier $85 q Cane and Crutch Holder $195 Frame and Accent Select desired frame and accent colors. Accent color is used on backrest rigidizer bar and front caster wings; if no accent color is selected, frame color will be used. Gloss Finish Frame Accent Matte Finish Frame Accent Black N/C q q Army Green N/C q q Blue Skies N/C q q Charcoal Gray N/C q q Bubblegum Pink N/C q q Emerald Green N/C q q Candy Blue N/C q q Iridescent Burgundy N/C q q Candy Purple N/C q q Iridescent Navy N/C q q Candy Red N/C q q Retro Red N/C q q Copper N/C q q Royal Blue N/C q q Granny Smith N/C q q Shadow Black N/C q q Metallic Fuchsia New! N/C q q Smooth White N/C q q Metallic Orange N/C q q Colored Anodizing Package Silver N/C q q Select desired color. If no selection is made, black will be used. Teal N/C q q Included in Colored Anodizing Package: Backrest plates, camber Yellow N/C q q tube, towers, CG clamps, side guard receivers, front caster forks (standard or unitine) and Dynamic 5th Wheel split clamp. Camber tube Hydrographics not included if Wheelchair Drive Ready is selected. Visit for current Hydrographic options. Available q Black N/C on frame only; please choose accent color above. Does not include q Blue $165 front caster wing. Note selection below. q Bright Green $165 q $695 q Orange $165 q Pewter $165 q Pink $165 q Purple $165 q Red $165 q Gold $165 DCN Pricing and specifications subject to change without notice Page 6 of 14

7 References A. Seat Width See Diagram 1 Measured from outside of frame tube on one side to outside of frame tube on other side. B. Seat Depth See Diagram 3 Measured from front of back posts to front edge of seat sling. Seat sling starts at beginning of bend at front of frame. C. Front Frame Bend See Diagram 3 Angle between front seat tube and ground. D. Sling Position See Diagram 2 With 0 Sling Position, sling is approximately 4 from the front tube. The 1 and 2 Sling Positions extend the frame in front of the sling by that amount. -1 pushes the seat 1 farther forward. See Charts 1 and 2 for more detail. E. Front Seat Height See Diagram 1 Measured from floor to top of seat tube at front of seat sling. F. Footrest Width See Diagram 1 Measured from inside of front tube to inside of front tube on other side. Footrest width is listed below for each seat width. See Chart 1 for more detail. G. Seat to Footrest Length See Diagram 3 Measured from front edge of seat sling to top of rear of footrest. Footrest length of at least 2.5 shorter than front seat height recommended. H. Rear Seat Height See Diagram 3 Measured from floor to top of seat tube at front of back post. Rear seat height is custom to needs. I. Center of Gravity Preset See Diagram 3 Measured from front of back post to center of rear axle. 0 indicates axle will be directly under back post. J. Rear Wheel Spacing See Diagram 1 Measured from outside of seat back to inside of rear tire. Adjustable up to.5 outward. Chart 1 F. Footrest Width Seat Straight Frame Width Offset Frame (Diagram 1) Diagram 1 J E Diagram 3 G Chart 2 Sling Position / Adjustable Depth / Seat Depth Compatibility Seat Depth Sling Position Adjustable Depth C A F B I -1, X 15 X X X 16 X X X X X X X indicates Sling Position, Adjustable Depth and Seat Depth combination is not available. -1 Sling Position, 0 Adjustable Depth and 8-13 Seat Depths have no restrictions. D H Diagram 2 DCN Pricing and specifications subject to change without notice Page 7 of 14

8 Axiom G, S and P Cushions Select size in chart at right. Weight capacity: 350 lbs. Cushions Under 22 Wide q Axiom G E2601 $120 q Axiom S E2603 $199 q Axiom P E2605 $ Wide Cushions q Axiom G E2602 $199 q Axiom S E2604 $299 q Axiom P E2606 $440 Axiom G, S or P Cushion Quantity: q 1 q 2 If no selection is made, quantity 1 will be selected Axiom SP Cushions Select size in chart at right. Weight capacity: 350 lbs. Cushions Under 22 Wide q Axiom SP - Visco E2607 $410 q Axiom SP - Fluid E2607 $ Wide Cushions q Axiom SP - Visco E2608 $499 q Axiom SP - Fluid E2608 $549 Axiom SP Cushion Quantity: q 1 q 2 If no selection is made, quantity 1 will be selected Axiom Accessories Outer Covers q Axiom G Extra Outer Cover $70 q Axiom S Extra Outer Cover $80 q Axiom P Extra Outer Cover $90 q Axiom SP Extra Visco Outer Cover $100 q Axiom SP Extra Fluid Outer Cover $100 Outer Cover Quantity: q 1 q 2 If no selection is made, quantity 1 will be selected Inner Covers q Axiom SP Extra Visco Inner Cover $100 q Axiom SP Extra Fluid Inner Cover $100 Inner Cover Quantity: q 1 q 2 If no selection is made, quantity 1 will be selected Depth Depth Width q 15 q q q 16 q q q q q q q 17 q q q q q q 18 q q q q q q q 19 q q q 20 q q q q q Width q q q 15 q q q q q 16 q q q q q q q q 17 q q q q q q q q 18 q q q q q q q q q 19 q q q q q q q q 20 q q q q q q q q Solid Seat Insert Select size in chart below. Weight capacity: 350 lbs. Solid Seat Insert $55 Depth Width q 15 q q q 16 q q q q q q q 17 q q q q q q 18 q q q q q q q 19 q q q 20 q q q q q Solid Seat Insert Quantity: q 1 q 2 If no selection is made, quantity 1 will be selected DCN Pricing and specifications subject to change without notice Page 8 of 14

9 Elite Back HCPCS Code: E2620 Weight Capacity: 300 lbs. STEP 1: Choose Back Size Quick Ship Quick Ship products are stocked q Matrx Elite Back 14 x 14 - PBE1414 $625 q Matrx Elite Back 14 x 16 - PBE1416 $625 q Matrx Elite Back 14 x 18 - PBE1418 $625 q Matrx Elite Back 15 x 14 - PBE1514 $625 q Matrx Elite Back 15 x 16 - PBE1516 $625 q Matrx Elite Back 15 x 18 - PBE1518 $625 q Matrx Elite Back 16 x 12 - PBE1612 $625 q Matrx Elite Back 16 x 14 - PBE1614 $625 q Matrx Elite Back 16 x 16 - PBE1616 $625 q Matrx Elite Back 16 x 18 - PBE1618 $625 q Matrx Elite Back 16 x 20 - PBE1620 $625 q Matrx Elite Back 17 x 16 - PBE1716 $625 q Matrx Elite Back 17 x 18 - PBE1718 $625 q Matrx Elite Back 17 x 20 - PBE1720 $625 q Matrx Elite Back 18 x 14 - PBE1814 $625 q Matrx Elite Back 18 x 16 - PBE1816 $625 q Matrx Elite Back 18 x 18 - PBE1818 $625 q Matrx Elite Back 18 x 20 - PBE1820 $625 q Matrx Elite Back 19 x 16 - PBE1916 $625 q Matrx Elite Back 19 x 18 - PBE1918 $625 q Matrx Elite Back 20 x 16 - PBE2016 $625 q Matrx Elite Back 20 x 18 - PBE2018 $625 q Matrx Elite Back 20 x 20 - PBE2020 $625 On Demand On Demand products are ordered with an extended lead time q Matrx Elite Back 14 x 10 - PBE1410 $625 q Matrx Elite Back 14 x 12 - PBE1412 $625 q Matrx Elite Back 14 x 20 - PBE1420 $625 q Matrx Elite Back 15 x 10 - PBE1510 $625 q Matrx Elite Back 15 x 12 - PBE1512 $625 q Matrx Elite Back 15 x 20 - PBE1520 $625 q Matrx Elite Back 16 x 10 - PBE1610 $625 q Matrx Elite Back 17 x 10 - PBE1710 $625 q Matrx Elite Back 17 x 12 - PBE1712 $625 q Matrx Elite Back 17 x 14 - PBE1714 $625 q Matrx Elite Back 18 x 10 - PBE1810 $625 q Matrx Elite Back 18 x 12 - PBE1812 $625 q Matrx Elite Back 19 x 10 - PBE1910 $625 q Matrx Elite Back 19 x 12 - PBE1912 $625 q Matrx Elite Back 19 x 20 - PBE1920 $625 q Matrx Elite Back 20 x 10 - PBE2010 $625 q Matrx Elite Back 20 x 12 - PBE2012 $625 STEP 2: Choose Back Hardware (Selection Required) Back Hardware q Easy Set Hardware - PBMH N/C Not available with Angle Adjustable Locking Flip Up or Tubular Flip Up Armrests, O2 Holder or welded rigidizer bar q Split Mounting Hardware - SMHU N/C DCN Pricing and specifications subject to change without notice Page 9 of 14

10 Elite Deep Back HCPCS Code: E2620 Weight Capacity: 300 lbs. STEP 1: Choose Back Size Quick Ship Quick Ship products are stocked q Matrx Elite Deep Back 14 x 16 - EDB1416 $760 q Matrx Elite Deep Back 14 x 18 - EDB1418 $760 q Matrx Elite Deep Back 15 x 16 - EDB1516 $760 q Matrx Elite Deep Back 15 x 18 - EDB1518 $760 q Matrx Elite Deep Back 16 x 16 - EDB1616 $760 q Matrx Elite Deep Back 16 x 18 - EDB1618 $760 q Matrx Elite Deep Back 16 x 20 - EDB1620 $760 q Matrx Elite Deep Back 17 x 16 - EDB1716 $760 q Matrx Elite Deep Back 17 x 18 - EDB1718 $760 q Matrx Elite Deep Back 17 x 20 - EDB1720 $760 q Matrx Elite Deep Back 18 x 16 - EDB1816 $760 q Matrx Elite Deep Back 18 x 18 - EDB1818 $760 q Matrx Elite Deep Back 18 x 20 - EDB1820 $760 q Matrx Elite Deep Back 19 x 18 - EDB1918 $760 q Matrx Elite Deep Back 19 x 20 - EDB1920 $760 q Matrx Elite Deep Back 20 x 16 - EDB2016 $760 q Matrx Elite Deep Back 20 x 18 - EDB2018 $760 q Matrx Elite Deep Back 20 x 20 - EDB2020 $760 On Demand On Demand products are ordered with an extended lead time q Matrx Elite Deep Back 14 x 12 - EDB1412 $760 q Matrx Elite Deep Back 14 x 20 - EDB1420 $760 q Matrx Elite Deep Back 15 x 10 - EDB1510 $760 q Matrx Elite Deep Back 15 x 12 - EDB1512 $760 q Matrx Elite Deep Back 15 x 20 - EDB1520 $760 q Matrx Elite Deep Back 16 x 10 - EDB1610 $760 q Matrx Elite Deep Back 16 x 12 - EDB1612 $760 q Matrx Elite Deep Back 17 x 10 - EDB1710 $760 q Matrx Elite Deep Back 17 x 12 - EDB1712 $760 q Matrx Elite Deep Back 18 x 10 - EDB1810 $760 q Matrx Elite Deep Back 18 x 12 - EDB1812 $760 q Matrx Elite Deep Back 19 x 10 - EDB1910 $760 q Matrx Elite Deep Back 19 x 12 - EDB1912 $760 q Matrx Elite Deep Back 19 x 16 - EDB1916 $760 q Matrx Elite Deep Back 20 x 10 - EDB2010 $760 q Matrx Elite Deep Back 20 x 12 - EDB2012 $760 STEP 2: Choose Back Hardware (Selection Required) Back Hardware q Easy Set Hardware - PBMH N/C Not available with Angle Adjustable Locking Flip Up or Tubular Flip Up Armrests, O2 Holder or welded rigidizer bar q Split Mounting Hardware - SMHU N/C DCN Pricing and specifications subject to change without notice Page 10 of 14

11 MX2 Back HCPCS Code: E2615 Weight Capacity: 250 lbs. The MX2 Back is On Demand only. On Demand products are ordered with an extended lead time. MX2 Back with Fixed Hardware MX2 Back with Quick Release Hardware Hardware included q Matrx MX2 Back w/ Fixed Hardware 14 x 06 - IMX21406-CFH $795 q Matrx MX2 Back w/ Fixed Hardware 14 x 09 - IMX21409-CFH $835 q Matrx MX2 Back w/ Fixed Hardware 14 x 12 - IMX21412-CFH $875 q Matrx MX2 Back w/ Fixed Hardware 14 x 16 - IMX21416-CFH $915 q Matrx MX2 Back w/ Fixed Hardware 15 x 06 - IMX21506-CFH $795 q Matrx MX2 Back w/ Fixed Hardware 15 x 09 - IMX21509-CFH $835 q Matrx MX2 Back w/ Fixed Hardware 15 x 12 - IMX21512-CFH $875 q Matrx MX2 Back w/ Fixed Hardware 15 x 16 - IMX21516-CFH $915 q Matrx MX2 Back w/ Fixed Hardware 16 x 06 - IMX21606-CFH $795 q Matrx MX2 Back w/ Fixed Hardware 16 x 09 - IMX21609-CFH $835 q Matrx MX2 Back w/ Fixed Hardware 16 x 12 - IMX21612-CFH $875 q Matrx MX2 Back w/ Fixed Hardware 16 x 16 - IMX21616-CFH $915 q Matrx MX2 Back w/ Fixed Hardware 17 x 06 - IMX21706-CFH $795 q Matrx MX2 Back w/ Fixed Hardware 17 x 09 - IMX21709-CFH $835 q Matrx MX2 Back w/ Fixed Hardware 17 x 12 - IMX21712-CFH $875 q Matrx MX2 Back w/ Fixed Hardware 17 x 16 - IMX21716-CFH $915 q Matrx MX2 Back w/ Fixed Hardware 18 x 06 - IMX21806-CFH $795 q Matrx MX2 Back w/ Fixed Hardware 18 x 09 - IMX21809-CFH $835 q Matrx MX2 Back w/ Fixed Hardware 18 x 12 - IMX21812-CFH $875 q Matrx MX2 Back w/ Fixed Hardware 18 x 16 - IMX21816-CFH $915 Hardware included q Matrx MX2 Back w/ QR Hardware 14 x 06 - IMX21406-QRH $820 q Matrx MX2 Back w/ QR Hardware 14 x 09 - IMX21409-QRH $860 q Matrx MX2 Back w/ QR Hardware 14 x 12 - IMX21412-QRH $900 q Matrx MX2 Back w/ QR Hardware 14 x 16 - IMX21416-QRH $940 q Matrx MX2 Back w/ QR Hardware 15 x 06 - IMX21506-QRH $820 q Matrx MX2 Back w/ QR Hardware 15 x 09 - IMX21509-QRH $860 q Matrx MX2 Back w/ QR Hardware 15 x 12 - IMX21512-QRH $900 q Matrx MX2 Back w/ QR Hardware 15 x 16 - IMX21516-QRH $940 q Matrx MX2 Back w/ QR Hardware 16 x 06 - IMX21606-QRH $820 q Matrx MX2 Back w/ QR Hardware 16 x 09 - IMX21609-QRH $860 q Matrx MX2 Back w/ QR Hardware 16 x 12 - IMX21612-QRH $900 q Matrx MX2 Back w/ QR Hardware 16 x 16 - IMX21616-QRH $940 q Matrx MX2 Back w/ QR Hardware 17 x 06 - IMX21706-QRH $820 q Matrx MX2 Back w/ QR Hardware 17 x 09 - IMX21709-QRH $860 q Matrx MX2 Back w/ QR Hardware 17 x 12 - IMX21712-QRH $900 q Matrx MX2 Back w/ QR Hardware 17 x 16 - IMX21716-QRH $940 q Matrx MX2 Back w/ QR Hardware 18 x 06 - IMX21806-QRH $820 q Matrx MX2 Back w/ QR Hardware 18 x 09 - IMX21809-QRH $860 q Matrx MX2 Back w/ QR Hardware 18 x 12 - IMX21812-QRH $900 q Matrx MX2 Back w/ QR Hardware 18 x 16 - IMX21816-QRH $940 DCN Pricing and specifications subject to change without notice Page 11 of 14

12 Mini Back Comes standard with Kidabra cover. Weight Capacity: 150 lbs. Quick Ship Quick Ship products are stocked q Matrx Mini Back 10 x 07 - MINI1007 $625 q Matrx Mini Back 10 x 10 - MINI1010 $625 q Matrx Mini Back 10 x 12 - MINI1012 $625 q Matrx Mini Back 10 x 14 - MINI1014 $625 q Matrx Mini Back 12 x 07 - MINI1207 $625 q Matrx Mini Back 12 x 10 - MINI1210 $625 q Matrx Mini Back 12 x 12 - MINI1212 $625 q Matrx Mini Back 12 x 14 - MINI1214 $625 q Matrx Mini Back 14 x 07 - MINI1407 $625 q Matrx Mini Back 14 x 10 - MINI1410 $625 q Matrx Mini Back 14 x 12 - MINI1412 $625 q Matrx Mini Back 14 x 14 - MINI1414 $625 Kid*ab*ra Cushion Weight Capacity: 150 lbs. HCPCS Code: E2615 On Demand On Demand products are ordered with an extended lead time q Matrx Mini Back 11 x 07 - MINI1107 $625 q Matrx Mini Back 11 x 10 - MINI1110 $625 q Matrx Mini Back 11 x 12 - MINI1112 $625 q Matrx Mini Back 11 x 14 - MINI1114 $625 q Matrx Mini Back 13 x 07 - MINI1307 $625 q Matrx Mini Back 13 x 10 - MINI1310 $625 q Matrx Mini Back 13 x 12 - MINI1312 $625 q Matrx Mini Back 13 x 14 - MINI1314 $625 HCPCS Code: E2607 Quick Ship Quick Ship products are stocked q Matrx Kid*ab*ra Cushion 12 x 12 - KA1212-VI $425 q Matrx Kid*ab*ra Cushion 12 x 14 - KA1214-VI $425 q Matrx Kid*ab*ra Cushion 14 x 12 - KA1412-VI $425 DCN Pricing and specifications subject to change without notice Page 12 of 14

13 Matrx Elite/Mini Laterals HCPCS Code: Swing Away Hardware, Offset Hardware E1028 / Fixed Hardware, Pad E0956 Quick Ship Quick Ship products are stocked Elite Swing Away Lateral Hardware Only - SAHEB q Quantity 1 $225 q Quantity 2 $450 q Elite Offset Swing Away Lateral Hardware Only (Left) - OSAH-L $225 q Elite Offset Swing Away Lateral Hardware Only (Right) - OSAH-R $225 Pad Only for Swing Away Lateral Medium 3.75 H x 5.75 L - EPAD-M q Quantity 1 $110 q Quantity 2 $220 Pad Only for Swing Away Lateral Large 4.25 H x 6.5 L - EPAD-L q Quantity 1 $110 q Quantity 2 $220 Hardware Options On Demand On Demand products are ordered with an extended lead time q Easy Set Hardware (Pair) - PBMH $225 q Split Mounting Hardware (Pair) - SMH $200 q Heavy Duty Easy Set Hardware (Pair) - HDMH $325 q Extended Range Mounting Hardware (Pair) - ERMH $225 q Fixed Space Saver Mounting Hardware (Pair) - FSSH $200 q Carbon Fiber Fixed Mount Hardware for MX2 Back - IMX2CFH $245 q Quick Release Hardware for MX2 Back - IMX2QRH $270 On Demand On Demand products are ordered with an extended lead time q Elite Lateral Fixed Hardware with Standard Pad 5 H x 7.5 L (Left) PBLS-L $110 q Elite Lateral Fixed Hardware with Standard Pad 5 H x 7.5 L (Right) PBLS-R $110 q Elite Lateral Fixed Hardware with Small Pad 3 H x 5.5 L (Left) PBSS-L $110 q Elite Lateral Fixed Hardware with Small Pad 3 H x 5.5 L (Right) PBSS-R $110 q Elite Lateral Fixed Hardware with Offset Pad 5 H x 7.5 L (Left) PBOL-L $110 q Elite Lateral Fixed Hardware with Offset Pad 5 H x 7.5 L (Right) PBOL-R $110 Mini Swing-Away Lateral Hardware Only - SAHMINI q Quantity 1 $225 q Quantity 2 $450 Pad for Swing Away Lateral X Small 3.25 H x 4.25 L - EPAD-XS q Quantity 1 $110 q Quantity 2 $220 Pad for Swing Away Lateral Small 3.5 H x 5.25 L - EPAD-S q Quantity 1 $110 q Quantity 2 $220 Other Matrx Products On Demand On Demand products are ordered with an extended lead time q Chest Harness Interface Kit for Elite Back - CHIEB $95 q Chest Harness Interface Kit for Mini Back - HIMINI $85 q Extended Mounting Pins for Mounting to Backs 2 Wider - EMP $60 q Privacy Flap X Small (Fits 12 to 14 Backs) - PFLAP-XS $40 q Privacy Flap Small (Fits 15 to 16 Backs) - PFLAP-S $40 q Privacy Flap Medium (Fits 17 to 18 Backs) - PFLAP-M $40 q Privacy Flap Large (Fits 19 to 20 Backs) - PFLAP-L $40 q Privacy Flap X Large (Fits 21 to 22 Backs) - PFLAP-XL $40 DCN Pricing and specifications subject to change without notice Page 13 of 14

14 Comfort Company Curve Cushion Weight capacity for cushions 13 wide and under: 100 lbs. Weight capacity for 14 wide cushions: 150 lbs. HCPCS Code: E2601 Quick Ship Quick Ship products are stocked q Comfort Company Curve Cushion 10 x 10 - CU-FV-1010 $99 q Comfort Company Curve Cushion 10 x 11 - CU-FV-1011 $99 q Comfort Company Curve Cushion 10 x 12 - CU-FV-1012 $99 q Comfort Company Curve Cushion 10 x 13 - CU-FV-1013 $99 q Comfort Company Curve Cushion 11 x 10 - CU-FV-1110 $99 q Comfort Company Curve Cushion 11 x 11 - CU-FV-1111 $99 q Comfort Company Curve Cushion 11 x 12 - CU-FV-1112 $99 q Comfort Company Curve Cushion 11 x 14 - CU-FV-1114 $99 q Comfort Company Curve Cushion 12 x 10 - CU-FV-1210 $99 q Comfort Company Curve Cushion 12 x 11 - CU-FV-1211 $99 q Comfort Company Curve Cushion 12 x 12 - CU-FV-1212 $99 q Comfort Company Curve Cushion 12 x 13 - CU-FV-1213 $99 q Comfort Company Curve Cushion 12 x 14 - CU-FV-1214 $99 q Comfort Company Curve Cushion 13 x 10 - CU-FV-1310 $99 q Comfort Company Curve Cushion 13 x 11 - CU-FV-1311 $99 q Comfort Company Curve Cushion 13 x 12 - CU-FV-1312 $99 q Comfort Company Curve Cushion 13 x 13 - CU-FV-1313 $99 q Comfort Company Curve Cushion 13 x 14 - CU-FV-1314 $99 q Comfort Company Curve Cushion 14 x 11 - CU-FV-1411 $99 q Comfort Company Curve Cushion 14 x 12 - CU-FV-1412 $99 q Comfort Company Curve Cushion 14 x 13 - CU-FV-1413 $99 On Demand On Demand products are ordered with an extended lead time q Comfort Company Curve Cushion 10 x 14 - CU-FV-1014 $99 q Comfort Company Curve Cushion 11 x 13 - CU-FV-1113 $99 q Comfort Company Curve Cushion 14 x 10 - CU-FV-1410 $99 DCN Pricing and specifications subject to change without notice Page 14 of 14